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Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation.

Ryu JA, Cho YH, Sung K, Choi SH, Yang JH, Choi JH, Lee DS, Yang JH - BMC Anesthesiol (2015)

Bottom Line: Thus, we investigated predictors of good neurological outcomes after successful ECPR.Excluded were 22 patients who did not survive more than 24 hours after ECPR and 90 patients who died from unknown causes or causes other than brain death or whose neurological status could not be assessed at discharge.Cardiac etiology was verified in 74 (64%) patients and therapeutic hypothermia was performed in 9 patients (8%); 68 (59%) had good neurological outcomes and 47 (41%) did not and 24 patients died from brain death.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) refers to use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary arrest. Although ECPR can increase survival rates after cardiac arrest, it can also result in poor post-resuscitation neurological status. Thus, we investigated predictors of good neurological outcomes after successful ECPR.

Methods: A total of 227 patients underwent ECPR from May 2004 to June 2013 at Samsung Medical Center. Successful ECPR was defined as survival more than 24 hours after ECPR. Neurological outcomes were assessed at discharge using the Glasgow-Pittsburgh Cerebral Performance Categories scale (CPC). CPC 1 and 2 were classified as good and CPC 3 to 5 were classified as poor neurological outcomes. Excluded were 22 patients who did not survive more than 24 hours after ECPR and 90 patients who died from unknown causes or causes other than brain death or whose neurological status could not be assessed at discharge. Multiple logistic regression analysis was used to identify independent predictors of neurological outcomes.

Results: Included were 115 patients with a mean age of 58 (range 45-66) years and 80 men (70%). Cardiopulmonary resuscitation (CPR) was performed at non-hospital sites for 19 (17%) patients and bystander CPR was performed in 9 of 19 cases (47%). Cardiac etiology was verified in 74 (64%) patients and therapeutic hypothermia was performed in 9 patients (8%); 68 (59%) had good neurological outcomes and 47 (41%) did not and 24 patients died from brain death. Neurological outcomes were affected by hemoglobin levels before ECMO (P = 0.02), serum lactic acid (P < 0.001) before ECMO insertion, and interval from cardiac arrest to ECMO (P = 0.04).

Conclusions: Low hemoglobin or high serum lactic acid levels before ECMO, and prolonged interval from cardiac arrest to ECMO predicted poor neurological outcomes after successful ECPR. Early institution of ECMO and a low threshold for blood transfusion might improve neurological outcomes for patients who survive ECPR.

No MeSH data available.


Related in: MedlinePlus

Population inclusion and exclusion criteria. ECPR, extracorporeal cardiopulmonary resuscitation.
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Fig1: Population inclusion and exclusion criteria. ECPR, extracorporeal cardiopulmonary resuscitation.

Mentions: From May 2004 to June 2013, 227 adult patients underwent ECPR at Samsung Medical Center. ECPR was defined as use of venoarterial ECMO intended to treat cardiac arrest. Successful ECPR was defined as survival longer than 24 hours after ECPR. Excluded were 22 patients who did not survive more than 24 hours after ECPR. Some patients who needed continuous sedation because of hemodynamic instability could not be awakened and spontaneous awakening trials were not possible. Some patients died from non-neurologic causes such as multiorgan failure, cardiac death, or uncontrolled infection. We excluded patients for whom we could not define neurological status because of continuous sedation or death from unknown causes or causes other than brain death. This resulted in 90 patients excluded and 115 patients included (Figure 1).Figure 1


Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation.

Ryu JA, Cho YH, Sung K, Choi SH, Yang JH, Choi JH, Lee DS, Yang JH - BMC Anesthesiol (2015)

Population inclusion and exclusion criteria. ECPR, extracorporeal cardiopulmonary resuscitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358703&req=5

Fig1: Population inclusion and exclusion criteria. ECPR, extracorporeal cardiopulmonary resuscitation.
Mentions: From May 2004 to June 2013, 227 adult patients underwent ECPR at Samsung Medical Center. ECPR was defined as use of venoarterial ECMO intended to treat cardiac arrest. Successful ECPR was defined as survival longer than 24 hours after ECPR. Excluded were 22 patients who did not survive more than 24 hours after ECPR. Some patients who needed continuous sedation because of hemodynamic instability could not be awakened and spontaneous awakening trials were not possible. Some patients died from non-neurologic causes such as multiorgan failure, cardiac death, or uncontrolled infection. We excluded patients for whom we could not define neurological status because of continuous sedation or death from unknown causes or causes other than brain death. This resulted in 90 patients excluded and 115 patients included (Figure 1).Figure 1

Bottom Line: Thus, we investigated predictors of good neurological outcomes after successful ECPR.Excluded were 22 patients who did not survive more than 24 hours after ECPR and 90 patients who died from unknown causes or causes other than brain death or whose neurological status could not be assessed at discharge.Cardiac etiology was verified in 74 (64%) patients and therapeutic hypothermia was performed in 9 patients (8%); 68 (59%) had good neurological outcomes and 47 (41%) did not and 24 patients died from brain death.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) refers to use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary arrest. Although ECPR can increase survival rates after cardiac arrest, it can also result in poor post-resuscitation neurological status. Thus, we investigated predictors of good neurological outcomes after successful ECPR.

Methods: A total of 227 patients underwent ECPR from May 2004 to June 2013 at Samsung Medical Center. Successful ECPR was defined as survival more than 24 hours after ECPR. Neurological outcomes were assessed at discharge using the Glasgow-Pittsburgh Cerebral Performance Categories scale (CPC). CPC 1 and 2 were classified as good and CPC 3 to 5 were classified as poor neurological outcomes. Excluded were 22 patients who did not survive more than 24 hours after ECPR and 90 patients who died from unknown causes or causes other than brain death or whose neurological status could not be assessed at discharge. Multiple logistic regression analysis was used to identify independent predictors of neurological outcomes.

Results: Included were 115 patients with a mean age of 58 (range 45-66) years and 80 men (70%). Cardiopulmonary resuscitation (CPR) was performed at non-hospital sites for 19 (17%) patients and bystander CPR was performed in 9 of 19 cases (47%). Cardiac etiology was verified in 74 (64%) patients and therapeutic hypothermia was performed in 9 patients (8%); 68 (59%) had good neurological outcomes and 47 (41%) did not and 24 patients died from brain death. Neurological outcomes were affected by hemoglobin levels before ECMO (P = 0.02), serum lactic acid (P < 0.001) before ECMO insertion, and interval from cardiac arrest to ECMO (P = 0.04).

Conclusions: Low hemoglobin or high serum lactic acid levels before ECMO, and prolonged interval from cardiac arrest to ECMO predicted poor neurological outcomes after successful ECPR. Early institution of ECMO and a low threshold for blood transfusion might improve neurological outcomes for patients who survive ECPR.

No MeSH data available.


Related in: MedlinePlus